PostPartum Care

BUBBLE-EE

breasts, uterus, bladder, bowel, lochia, episiotomy, extremities, emotional status

what are the negative implications of a full bladder

A full bladder interferes with uterine contraction and may lead to hemorrhage, because it will displace the uterus out of the midline.

What temperature must be reported to the physician due to concern for infection in the postpartum period?

A temperature above 100.4° F (38° C) at any time or an abnormal temperature after the first 24 hours may indicate infection and must be reported.

what characteristics of lochia are important to assess

Assess lochia in terms of amount, color, odor, and change with activity and time

bonding typically develops during which time frame after birth?

Bonding is the close emotional attraction to a newborn by the parents that develops during the first 30 to 60 minutes after birth. It is unidirectional, from parent to infant. It is thought that optimal bonding of the parents to a newborn requires a period of close contact within the first few minutes to a few hours after birth

A new mother who is breastfeeding reports that her right breast is very hard, tender, and painful. Upon examination the nurse notices several nodules and the breast feels very warm to the touch. What do these findings indicate to the nurse? You Selected:

Engorged breasts are hard, tender, and taut. If the breasts have nodules, masses, or areas of warmth, they may have plugged ducts, which can lead to mastitis if not treated promptly.

why are women at risk for blood clots after birth

Normal physiologic changes of pregnancy, including alterations in hemostasis that favor coagulation, reduced fibrinolysis, and pooling and stasis of blood in the lower limbs, place women at risk for blood clots surgery, including C-section, places women at even higher risk. There is also vessel damage during delivery/labor that worsens matters.

A client gave birth 2 days ago and is preparing for discharge. The nurse assesses respirations to be 26 rpm and labored, and the client was short of breath ambulating from the bathroom this morning. Lung sounds are clear. The nurse alerts the primary care provider and the nurse-midwife to her concern that the client may be experiencing:

PE

A client who has given birth is being discharged from the health care facility. She wants to know how safe it would be for her to have intercourse. Which instructions should the nurse provide to the client regarding intercourse after birth?

Resume intercourse if bright red bleeding stops; general guidance is 4-6 weeks

During the discharge planning for new parents, what would the case manager do to help provide the positive reinforcement and ensure multiple assessments are conducted?

Schedule home visits for high-risk families.

after birth, what happens to the foramen ovale

The foramen ovale will close off the first few minutes after birth because the pressures in the L atrium are now higher than the R atrium (due to decreased pulmonary resistance after birth), pushing the flap of tissue over the opening.

A client is Rh-negative and has given birth to her newborn. What should the nurse do next?

The nurse first needs to determine the rhesus of the newborn to know if the client needs Rh immunoglobulins. Mothers who are Rh-negative and have given birth to an infant who is Rh-positive should receive an injection of Rh immunoglobulin within 72 hours after birth; this prevents a sensitization reaction to Rh-positive blood cells received during the birthing process. Women should receive the injection regardless of how many children they have had in the past.

what is a peribottle and when should it be used

The peribottle is a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area after each voiding and before applying a new perineal pad

The client, who has just been walking around her room, sits down and reports leg tightness and achiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to which cause?

Thromboembolic disorders may present with subtle changes that must be evaluated with more than just physical examination. The woman may report lower extremity tightness or aching when ambulating that is relieved with rest and elevation. Edema in the affected leg, along with warmth and tenderness and a low grade fever, may also be noted.

what type of contraception is best in the postpartum period

condoms, oral hormonal contraceptives may increased a woman's risk of DVT

why do some women have a low grade fever after birth

dehydration, excessive fluid losses during birth

what are ways to suppress milk production in the bottle feeding mother

do not pump or go in hot shower--these will stimulate milk production instead, use ice packs, wear a snug bra, and take acetaminophen

Which nursing intervention is appropriate for prevention of a urinary tract infection (UTI) in the postpartum woman?

encouraging the woman to empty her bladder completely every 2 to 4 hours

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration?

fourth degree

A client who gave birth to twins 6 hours ago becomes restless and nervous. Her blood pressure falls from 130/80 mm Hg to 96/50 mm Hg. Her pulse drops from 80 to 56 bpm. She was induced earlier in the day and experienced abruptio placentae. Based on this information, what postpartum complication would the nurse expect is happening?

hemorrhage

what happens to the Wharton's Jelly when the umbilical cord is clamped

it starts to contract, creating a high resistance in the umbilical cord ("a natural clamp")

risk factors for postpartum hemorrhage

placenta previa or abruptio placenta labor induction operative procedures (vacum, forceps) large infant/twins - uterine over distention prolonged 3rd stage of labor

risk factors for postpartum infection

prolonged labor multiple vaginal exams during labor forceps/vaccum birth PROM anemia catheter

immediately after birth, the placenta is expelled and prostaglandin levels go.... What are the side effects of this change?

prostaglandin levels go down. This enhances constriction of the muscles of the ductus arteriousus and the tip of the umbilical cord.

immediately after birth, the lungs take in air or water?

the lungs take in air for the first time

The nurse who is working with parents and their newborn encourages which action to assist the bonding and attachment between them?

touching, kangaroo care Talking can happen during touching

how long does it take postpartum women's bowels function to return to normal

up to 1 week

what could a boggy uterus indicate

uterine atony Could be due to displacement of the uterus from an over distended bladder or retained placental fragments -- both put a women at risk for hemorrhage

The nurse is observing a client who gave birth yesterday. Where should the nurse expect to find the top of the client's fundus?

After a client gives birth, the height of her fundus should decrease by approximately one fingerbreadth (1 cm) each day. By the end of the first postpartum day, the fundus should be one fingerbreadth below the umbilicus. Immediately after birth, the fundus may be above the umbilicus; 6 to 12 hours after birth, it should be at the level of the umbilicus; 10 days after birth, it should be below the symphysis pubis.

When teaching the new mother about breastfeeding, the nurse is correct when providing what instructions?

Place baby in uninterrupted skin-to-skin contact with the mother. Encourage breastfeeding of the newborn infant on demand. Help the mother initiate breastfeeding within 30 minutes of birth.

when are ice packs used

perineal area for a tear, edema, or episiotomy. An ice pack seems to minimize edema, reduce inflammation, decrease capillary permeability, and reduce nerve conduction to the site. 20 minutes on/20 minutes off

A pregnant woman's pulse fluctuates throughout pregnancy and the early postpartum period. When assessing a 1-day postpartum woman's pulse, what is the first action a nurse should take in response to a rate of 56 bpm?

Compare the pulse rate of 56 bpm with her pulse rate on the first prenatal care visit.

Types of lacerations

First-degree laceration: involves only skin and superficial structures above muscle Second-degree laceration: extends through perineal muscles Third-degree laceration: extends through the anal sphincter muscle Fourth-degree laceration: continues through anterior rectal wall

A nurse is instructing a client who is breastfeeding for the first time that before her milk comes in she should expect to see colostrum, which is described as which color?

If a woman has any discharge from her nipples postpartum, it should be described and documented if it is not colostrum (creamy yellow) or foremilk (bluish white).

when does lochia flow increase

Lochia flow will increase when the woman gets out of bed (lochia pools in the vagina and the uterus while she is lying down) and when she breast-feeds (oxytocin release causes uterine contractions)

after birth, do the newborn's lungs have high or lower resistance?

Low resistance after birth because we have air in the alveoli (not fluid) which creates a higher O2 concentration in the alveoli. This higher concentration causes the pulmonary vasculature, specifically the arterioles to dilate and decrease overall lung resistance

puerperal bradycardia.

Pulse rates of 60 to 80 beats per minute (bpm) at rest are normal during the first week after birth

Describe the different amounts of lochia

Scant: a 1- to 2-in lochia stain on the perineal pad or approximately a 10-mL loss Light or small: an approximately 4-in stain or a 10- to 25-mL loss Moderate: a 4- to 6-in stain with an estimated loss of 25 to 50 mL Large or heavy: a pad is saturated within 1 hour after changing it

After birth, what happens to the ductus venosus

The blood flowing through the umbilical vein starts clotting off after the cutting of the umbilical cord. This will decrease the amount of blood flow through the umbilical vein and ductus venosus. Hence, these two structures essentially become unused over the course of a few days after birth.

After birth, what happens o the ductus arteriosus

a) Over a course of a few hours after birth, the smooth muscles of the ductus arteriosus sense that oxygen levels in the blood are now high and the muscles in the ductus will start to constrict. The ductus also senses that the placenta is removed because prostaglandin levels fall (the placenta makes prostaglandins and now the placenta has been removed.) This ongoing constriction will eventually cause the ductus to close completely.

immediately after birth, the environmental temp of the newborn goes.....

down